title: [Redesign of community-based health services: the solution for decreasing the quality gap].
abstract: The quality gap is defined as the gap between the observed and the expected, evidence-based, quality indicators. Experts agree that significant reduction of the quality gap requires transformation of the current system of health care provision. Maccabi Healthcare Services has formulated a "change package" in order to redesign its community-based healthcare services. This is based on a proactive approach in primary care, which manages all aspects of health for a defined community of members. This is built on multidisciplinary team-work, led by a physician and a nurse; planned visits for the management of patients with chronic diseases; one-stop-shopping for efficient health promotion; and encouraging patient-centeredness, which ensures that patient values will guide all clinical decisions and patients will be provided with support to enable self-management. The following conditions and infrastructure were required to allow for the redesign: 1) Redesign became a focus of the organizational strategy; 2) Building a comparative performance measurement for presentation at all managerial levels; 3) Agreement on the incentives to primary care clinics, which voluntarily joined the process of change; training of "quality leaders" who will use common terms and methodology to improve the quality of care. Starting in 2005 as a "pilot project", the change process has gradually evolved to include about 50 primary care clinics towards the end of the year 2007.
authors.affiliation: Maccabi Healthcare Services. Rachel_m@mac.org.ile-mail
authors.forename: Rachel
authors.initials: R
authors.lastname: Wilf-Miron
authors.forename: Hagai
authors.initials: H
authors.lastname: Kedem
authors.forename: Anthony
authors.initials: A
authors.lastname: Heiman
authors.forename: Dorit
authors.initials: D
authors.lastname: Goldman
authors.forename: Orna
authors.initials: O
authors.lastname: Shem-Tov
authors.forename: Ehud
authors.initials: E
authors.lastname: Kokia
mesh_terms: D003151:Community Health Centers / Q000458:organization & administration / Q000592:standards*; D003153:Community Health Services / Q000592:standards*; D005160:Facility Design and Construction / Q000592:standards*; D006801:Humans; D007557:Israel; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011785:Quality Assurance, Health Care